Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2022; 14(6): 1162-1174
Published online Jun 15, 2022. doi: 10.4251/wjgo.v14.i6.1162
Clinicopathological differences, risk factors and prognostic scores for western patients with intestinal and diffuse-type gastric cancer
Cristina Díaz del Arco, Lourdes Estrada Muñoz, Luis Ortega Medina, Elena Molina Roldán, M Ángeles Cerón Nieto, Soledad García Gómez de las Heras, M Jesús Fernández Aceñero
Cristina Díaz del Arco, Luis Ortega Medina, Elena Molina Roldán, M Ángeles Cerón Nieto, M Jesús Fernández Aceñero, Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid 28040, Spain
Cristina Díaz del Arco, Luis Ortega Medina, M Jesús Fernández Aceñero, Department of Legal Medicine, Psychiatry and Pathology, Complutense University of Madrid, Madrid 28040, Spain
Lourdes Estrada Muñoz, Department of Surgical Pathology, Hospital Rey Juan Carlos, Madrid 28933, Spain
Lourdes Estrada Muñoz, Soledad García Gómez de las Heras, Department of Basic Medical Sciences, Rey Juan Carlos University, Madrid 28933, Spain
Author contributions: Díaz del Arco C participated in the data acquisition, analysis, interpretation, manuscript draft, approval and agreement; Estrada Muñoz L participated in the data acquisition, analysis, manuscript revision, approval and agreement; Ortega Medina L participated in the study design, data interpretation, manuscript revision, approval and agreement; Molina Roldán E, Cerón Nieto MA, García Gómez de las Heras S participated in the data acquisition, manuscript revision, approval and agreement; Fernández Aceñero MJ participated in the study design, data analysis and interpretation, manuscript draft, approval and agreement.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Hospital Clínico San Carlos.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: Data will be available on request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Cristina Díaz del Arco, MD, Staff Physician, Associate Professor, Department of Surgical Pathology, Hospital Clínico San Carlos, c/ Profesor Martín Lagos s/n, Madrid 28040, Spain. crisdelarco@gmail.com
Received: December 30, 2021
Peer-review started: December 30, 2021
First decision: March 13, 2022
Revised: April 1, 2022
Accepted: May 27, 2022
Article in press: May 27, 2022
Published online: June 15, 2022
ARTICLE HIGHLIGHTS
Research background

In the molecular era, the Laurén system is still a cost-effective and widely implemented classification for gastric cancer (GC) and it has been recently associated with clinical, histological and molecular features of these tumors. Laurén subtypes have also shown differences in response to systemic therapy.

Research motivation

Despite recent advances in the understanding of the molecular biology of GC, there is a need to develop new prognostic tools for patient stratification in clinical practice. The implementation of specific scores for patients with intestinal and diffuse-type GC may significantly improve risk assessment and management of GC.

Research objectives

Our aims were to: (1) evaluate the clinicopathological differences between Laurén subtypes; (2) identify specific risk factors for these subtypes; and (3) develop prognostic scores for patients with intestinal and diffuse-type GC.

Research methods

This is a retrospective study of all patients undergoing surgery for GC at a tertiary referral center from 2001 to 2019. Clinical data and gross findings were collected. Histological and immunohistochemical features were assessed by two independent pathologists and prognostic scores were developed based on hazard ratios.

Research results

In our series of western patients with GC, intestinal and diffuse-type tumors showed distinctive epidemiological, clinical and prognostic features. In addition, Laurén subtypes were associated with different risk factors for tumor progression and cancer-specific death. Our prognostic scores for predicting overall survival and disease-free survival in patients with intestinal and diffuse-type GC included clinicopathological variables that can be easily calculated in clinical practice and showed an excellent patient stratification into three (diffuse GC) or four (intestinal GC) prognostic groups.

Research conclusions

The stratification of GC patients depending on Laurén subtypes and the implementation of specific clinicopathological prognostic scores in intestinal and diffuse-type tumors can be useful for patient stratification, risk assessment and treatment selection.

Research perspectives

Our prognostic scores should be externally validated in patients from both western and eastern countries due to the geographical variation of GC. In addition, this study opens a door to the development and implementation of cost-effective and specific clinicopathological prognostic scores in patients with GC in different contexts.